NY S07828

Establishes new regulations for pharmacy benefit managers (PBMs) under Public Health Law Section 280-a and creates Insurance Law Article 29 requiring registration by April 1, 2020 and licensing by January 1, 2022.

Requires PBMs to act with fiduciary duty to covered individuals and health plans, prioritizing covered individuals' interests when conflicts arise, and to account annually for all rebates, discounts, clawbacks, and other financial benefits received.

Prohibits PBMs from substituting prescription drugs without prescriber approval, preventing gag clauses that restrict pharmacists from discussing costs or alternative medications, and prohibiting copayments exceeding pharmacy charges.

Establishes a 30-day appeals process for pharmacies to challenge maximum allowable cost pricing for generic drugs, requiring PBMs to respond within seven business days and adjust pricing for all similarly situated network pharmacies if appeals are valid.

Creates registration and licensing fees ($1,000 annually for registration, $2,000 annually for licenses) and grants the Superintendent of Financial Services authority to establish minimum standards, conduct examinations, and impose penalties up to $2,500 per violation or aggregate gross receipts attributable to violations.